The higher the use of nonsteroidal anti-inflammatory drugs (NSAIDs), the more reports of adverse drug reactions, especially in children than in adults. As patients with fever take several NSAIDs alternatively, suspected symptoms allergic to drugs with different chemical structures are also experienced in the clinical field. This is because it appears not only through immunological mechanisms but also through cross-intolerant reactions. Therefore, when hypersensitivity to one or more NSAIDs is present, it is important to distinguish between the 2 mechanisms for future treatment planning. Although it is difficult to distinguish between the 2 mechanisms by clinical history, drug provocation test with aspirin is helpful in diagnosis. A 4-year-old patient who had urticaria/angioedema and shortness of breath after taking ibuprofen and acetaminophen visited Kangwon National University Hospital for a treatment plan using antipyretics and/or analgegics forward. We propose a diagnosis and treatment protocol for such patients with a brief literature review.

Purpose: Anaphylaxis may be life-threatening, and thus requires early recognition and a rapid response. We investigated current demands imposed by anaphylaxis and the responses of pediatric and youth educational institutions. We surveyed school nurses and childcare teachers in Gangwon-do Province, South Korea. Methods: The online survey featured 2 questionnaires: one exploring demands imposed by anaphylaxis and the current response status and the other evaluating awareness of anaphylaxis among school nurses and childcare teachers. Results: A total of 105 school nurses and 263 childcare teachers responded, of whom 16.2% and 1.9% reported that they had encountered anaphylaxis at work, and 6.7% and 11.0% had epinephrine auto-injectors (EAIs) available, respectively. Furthermore, 7.6% of school nurses and 3.0% of childcare teachers had been requested by parents to obtain institutional EAIs. Screening for anaphylaxis at the beginning of each school year was performed in 81.9% of schools and 41.1% of childcare institutions, and 55.2% of schools and 44.5% of childcare institutions had formulated action plans for anaphylaxis. Anaphylaxis education had been received by 72.4% of school nurses and 38.8% of childcare teachers. However, anaphylaxis awareness and coping skills seemed to be lacking in most participants. Conclusion Given the nontrivial numbers of pediatric patients with anaphylaxis and thus the demand for assistance, the lack of institutional prevention and management systems (screening, action plans, and coping skills) is of concern. In addition to increasing teacher awareness, institutional changes are required.

Purpose: This study evaluated the impact of auricular acupressure on depression among nurses. Methods: This study used a randomized control group pretest-posttest design. Shift-work nurses with the Patient Health Questionnaire-9 (PHQ-9) score over 5 points were randomized to the experimental group(n=20) or the control group(n=20). For the experimental group, auricular acupressure was conducted at the corresponding points of depression (TGI, AH1) weekly for seven days as well as for two weeks. The PHQ-9 was completed before intervention, as well as two weeks after intervention. Results: The mean difference in the PHQ-9 score before and after auricular acupressure in the experimental group (-4.11±2.27), was more significant than in the control group (-1.72±3.82) (t=2.28, p=.03). Conclusion Result showed that nurses who received auricular acupressure had a decrease in depression, compared to those who did not receive auricular acupressure. Further research is required, to apply the other auricular acupressure points, to evaluate the impact on depressive symptoms.

Purpose: Long-term oncologic differences in outcome between groups of patients with Lynch syndrome (LS) colorectal cancer (CRC) and sporadic CRC with microsatellite instability-high (MSI-H) are the focus of investigation in the current study. Methods: Patients registered in the Korean Hereditary Tumor Registry and 2 tertiary referral hospitals treated for stage I– III CRC between 2005 and 2015 were retrospectively analyzed. Detection for both groups was performed using pedigree, microsatellite instability, and mismatch repair (MMR) gene testing. Multivariate analyses for overall survival (OS) and disease-free survival (DFS) were conducted. Results: Cases of LS (n = 77) and sporadic CRC with MSI-H (n = 96) were identified. LS CRC patients were younger in age and displayed tumor sidedness, typically involving left-sided colon and rectum, compared to patients with sporadic CRC with MSI-H. OS and DFS were lower for LS CRC relative to CRC with MSI-H (OS, 72.7% vs. 93.8%, P = 0.001; DFS, 71.4% vs. 88.5%, P = 0.001). In multivariate analyses, tumor sidedness, stage, and chemotherapy were independent factors for OS and DFS. LS CRC was a prognostic factor for poorer OS (hazard ratio, 2.740; 95% confidence interval, 1.003–7.487; P = 0.049), but not DFS. Conclusion Our findings indicate that LS CRC is associated with poorer outcomes compared to sporadic CRC with MSI-H, presenting distinct clinical features. In view of the current lack of knowledge on genetic and molecular mechanisms, appropriate management taking into consideration the difficulty of identification of CRC with hypermutable tumors harboring heterogeneity is essential.

Background/Aims: The mucoprotective drug rebamipide is used to treat gastritis and peptic ulcers. We compared the efficacy of Mucosta Ⓡ (rebamipide 100 mg) and its new formulation, AD-203 (rebamipide 150 mg), in treating erosive gastritis. Methods: This double-blind, active control, noninferiority, multicenter, phase 3 clinical trial randomly assigned 475 patients with endoscopically proven erosive gastritis to two groups: AD-203 twice daily or Mucosta Ⓡ thrice daily for 2 weeks. The intention-to-treat (ITT) analysis included 454 patients (AD-203, n=229; Mucosta Ⓡ , n=225), and the per-protocol (PP) analysis included 439 patients (AD-203, n=224; Mucosta Ⓡ , n=215). The posttreatment assessments included the primary (erosion improvement rate) and secondary endpoints (erosion and edema cure rates; improvement rates of redness, hemorrhage, and gastrointestinal symptoms). Drug-related adverse events were evaluated. Results: According to the ITT analysis, the erosion improvement rates (posttreatment) in AD-203-treated and Mucosta Ⓡ -treated patients were 39.7% and 43.8%, respectively. According to the PP analysis, the erosion improvement rates (posttreatment) in AD-203-treated and Mucosta Ⓡ -treated patients were 39.3% and 43.7%, respectively. The one-sided 97.5% lower limit for the improvement rate difference between the study groups was −4.01% (95% confidence interval [CI], –13.09% to 5.06%) in the ITT analysis and −4.44% (95% CI, –13.65% to 4.78%) in the PP analysis. The groups did not significantly differ in the secondary endpoints in either analysis. Twenty-four AD-203-treated and 20 Mucosta Ⓡ -treated patients reported adverse events but no serious adverse drug reactions; both groups presented similar adverse event rates. Conclusions The new formulation of rebamipide 150 mg (AD-203) twice daily was not inferior to rebamipide 100 mg (Mucosta Ⓡ ) thrice daily. Both formulations showed a similar efficacy in treating erosive gastritis.

Purpose: Long-term oncologic differences in outcome between groups of patients with Lynch syndrome (LS) colorectal cancer (CRC) and sporadic CRC with microsatellite instability-high (MSI-H) are the focus of investigation in the current study. Methods: Patients registered in the Korean Hereditary Tumor Registry and 2 tertiary referral hospitals treated for stage I– III CRC between 2005 and 2015 were retrospectively analyzed. Detection for both groups was performed using pedigree, microsatellite instability, and mismatch repair (MMR) gene testing. Multivariate analyses for overall survival (OS) and disease-free survival (DFS) were conducted. Results: Cases of LS (n = 77) and sporadic CRC with MSI-H (n = 96) were identified. LS CRC patients were younger in age and displayed tumor sidedness, typically involving left-sided colon and rectum, compared to patients with sporadic CRC with MSI-H. OS and DFS were lower for LS CRC relative to CRC with MSI-H (OS, 72.7% vs. 93.8%, P = 0.001; DFS, 71.4% vs. 88.5%, P = 0.001). In multivariate analyses, tumor sidedness, stage, and chemotherapy were independent factors for OS and DFS. LS CRC was a prognostic factor for poorer OS (hazard ratio, 2.740; 95% confidence interval, 1.003–7.487; P = 0.049), but not DFS. Conclusion Our findings indicate that LS CRC is associated with poorer outcomes compared to sporadic CRC with MSI-H, presenting distinct clinical features. In view of the current lack of knowledge on genetic and molecular mechanisms, appropriate management taking into consideration the difficulty of identification of CRC with hypermutable tumors harboring heterogeneity is essential.

Esophageal cancer is easy to infiltrate and metastasize because esophagus does not have serosa, and is difficult to remove it because esophagus is in the middle of the chest. Because of this, treatments of esophageal cancer do not always follow the guideline. In this situation, efforts to increase treatment efficiency and improve survival rate through multidisciplinary treatment are increasing. In this case, we report the patient with three superficial esophageal cancers (one in cervical esophagus and two in thoracic esophagus). The patient was treated with concurrent chemoradiotherapy instead of surgery through multidisciplinary discussion. The patient reached a complete remission through this discussion. This case is intended to inform the usefulness of multidisciplinary treatment in patients with esophageal cancer.

Purpose: Anaphylaxis is life-threatening, so early recognition and proper response are critical. This study evaluated the awareness of anaphylaxis in Korean community including teachers, 119 rescue team, and doctors in public service. Methods: A questionnaire of anonymously structured 9 items about anaphylaxis was administered to the teachers working in kindergartens or elementary schools, 119 rescue team, and public health physicians in Gangwon province in 2017. Additional questionnaire about knowledge on anaphylaxis management was administered to the physicians. Results: A total of 415 people participated in the survey. About 4% of child care and health teachers experienced anaphylaxis within 1 year, but the overall awareness of anaphylaxis was very low, regardless of the educational level of anaphylaxis. 119 rescue teams experienced more anaphylactic patients, but they lacked knowledge of epinephrine administration and epinephrine autoinjector (EAI), independent of the educational level of anaphylaxis. Public health physicians had good knowledge of early treatment for anaphylaxis, but there was a lack of knowledge for epinephrine injection sites, observation plan, and EAI. Conclusion The awareness of anaphylaxis among community and emergency responders seems likely to be inadequate. Systematic and continuous education by anaphylaxis specialists is necessary for community health care providers.

Esophageal cancer is easy to infiltrate and metastasize because esophagus does not have serosa, and is difficult to remove it because esophagus is in the middle of the chest. Because of this, treatments of esophageal cancer do not always follow the guideline. In this situation, efforts to increase treatment efficiency and improve survival rate through multidisciplinary treatment are increasing. In this case, we report the patient with three superficial esophageal cancers (one in cervical esophagus and two in thoracic esophagus). The patient was treated with concurrent chemoradiotherapy instead of surgery through multidisciplinary discussion. The patient reached a complete remission through this discussion. This case is intended to inform the usefulness of multidisciplinary treatment in patients with esophageal cancer.

Oropharyngeal dysphagia is a clinical condition caused by various underlying diseases and is characterized by difficulty in swallowing. Diagnosis and treatment of oropharyngeal dysphagia require multidisciplinary consultations. This position statement for oropharyngeal dysphagia was developed by The Korean Dysphagia Society (KDS) to outline its position on oropharyngeal dysphagia. The clinical practice guideline, position statements, a recent meta-analysis, a systematic review, and randomized controlled trials for oropharyngeal dysphagia were all performed. An expert Delphi survey was also done to achieve a consensus of opinion on this position statement. This position statement for oropharyngeal dysphagia aims to help make evidence-based decisions in clinical practice, improve clinical evaluation and manage oropharyngeal dysphagia in Korea.